Provider First Line Business Practice Location Address:
1016 SW KENYON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98106-2062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-838-9595
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2013